County Medical Services

CMS Frequently Asked Questions

What is CMS?

CMS is not health insurance; it is a program of last resort for eligible adults, which covers only necessary medical services. CMS uses a network of Community Health Centers, private physicians and local hospitals to provide the services. Community Health Centers throughout the County can evaluate your medical condition and give you information about a variety of programs that can help you get  the medical care you need. A listing of CMS providers can be found in the CMS Patient Handbook.

Applying for CMS

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Requirements for CMS

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  • What are the Requirements for CMS?

    Minimum Eligibility Criteria:

    • Have an immediate or long-term medical need
    • Be 21 through 64 years of age
    • Be a U.S. citizen or eligible non-citizen and be able to provide proof
    •  Be a resident of San Diego County
    • Sign lien forms for services covered by CMS
    • Meet CMS financial requirements

     

  • What are the income guidelines for CMS?

    The income guidelines vary depending upon the number of people in your family. If your family income is between 0-165% of the Federal Poverty Level (FPL), then you may be eligible for CMS at no cost. If your family income is more than 165% of FPL, you may be eligible for CMS with or without a Share of Cost under the CMS Hardship program. 

  • What is acceptable CMS verifications for citizenship?

    Examples of acceptable verification include:

    • U.S. Passport issued without limitations
    • Certificate of Naturalization (N-550 or N-570)
    • Certificate of U.S. Citizenship (N-560 or N-561)
    • U.S. Birth Certificate issued by the State, Commonwealth, Territory or local Jurisdiction

CMS Coverage

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  • I have CMS, can I use it with any doctor?

    No. When you were certified for CMS, you were asked to choose one of the community health centers as your primary care provider. You should go to the community health center you selected for your care.

  • What services are not covered by CMS?

    CMS does not cover:

    • Routine physical examinations and preventive care
    • Routine dental and vision care
    • Pregnancy/family planning/ infertility services
    • Organ, limb, and bone marrow transplants and related services
    • Visits to the emergency room for follow-up and prescription refills
    • Treatment of mental health, alcohol and drug problems
    • Prescriptions not approved by the Food & Drug Administration (FDA)
    • Participation in clinical trials including related medications, treatments, procedures, or professional components 
  • Does County Medical Services cover medications?

    CMS covers medications that are on the approved list. If your medication is not on the approved list, your primary care physician may submit a treatment authorization request (TAR) to CMS for review.

  • Where can I get my prescriptions filled?

    Prescriptions must be filled by a CMS contracted pharmacy or by your primary care provider. A list of CMS Pharmacies can be found in your CMS Patient Handbook. You can also find the CMS Patient Handbook by clicking on the "CMS Handbooks" icon on the CMS home page.

  • Does CMS cover dental services?

    CMS covers emergency dental care ONLY at a CMS dental clinic. CMS does not provide complete dental care such as routine check-ups, cleaning, or dentures. 

  • Where can I see a dentist?

    A complete list of authorized dentists is listed in your CMS Patient Handbook. You can also find the CMS Patient Handbook by clicking the "CMS Handbooks" icon from the CMS home page.

Share of Cost (SOC) 

(Only affects those who have applied for the CMS Hardship)

 

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  • What is Share of Cost (SOC)?

    The SOC is the amount that you must pay or be obligated to pay toward the cost of CMS covered health care services (including approved prescriptions) each month you receive CMS services. This is different from the Reimbursement Agreement and Lien described below, which might be collected until a future date.

  • How much will my SOC bill be?

    Your worker will determine the amount of your monthly SOC, and you will be notified of this amount and how it was calculated.

  • Am I required to pay my SOC every month?

    Only if you receive CMS services every month. You will not be responsible for paying your SOC in months you do not receive CMS services. 

  • How do I pay my SOC?

    You will be billed the amount of your SOC or CMS services, whichever is less. You will not be billed for any months for which you do not receive CMS services. The billing statement will include the address where to send the monthly payments. Do not send payments to CMS until you receive a billing statement. Do not send cash. The County will not accept cash payments.

  • Is interest added to what I owe?

    No.

  • When will I be required to make payments?

    When you receive a bill from the County, it is due. If you have questions regarding SOC billing and collection, you can call our SOC bill representative at 1-800-587-8118.

  • I just saw my physician, when will I receive a statement?

    Once all claims are received from your health care provider:

    • If your Share of Cost has been satisfied for the month, a monthly statement will be sent.
    • If your Share of Cost is not satisfied for the month, a quarterly statement will be sent.

     

  • Why did I receive a statement?

    Based on your recent CMS and CMS Hardship applications, you were approved CMS with a Share of Cost. You received a statement because you received CMS services and are responsible for paying your Share of Cost.

  • Can I pay the SOC with credit cards?

    Yes. The County accepts Master Card, Visa, and Discover. You may also make payments with personal checks, cashier’s checks or money orders. The County does not accept cash payments.

Reimbursement Agreement

(Only affects those who have applied for the CMS Hardship)

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Liens

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For more information call us at 1-800-587-8118.